May 2015
Dear (Editor):
Studies have shown that the usage of the Patient Connect Application increases patient
satisfaction scores in Press Ganey. It is important for health systems to be ranked higher in Press
Ganey over the local competitors so that more patients will come to their facility. Patient
Connect App is a way to increase patient satisfaction scores, so it is important to try to
implement the Application to its fullest potential to generate those results. The Patient Connect
App helps the department to determine patients’ needs while they are needed, not after the fact,
which could help the patient satisfaction tremendously.
This study will help promote the importance of patient satisfaction scores through Press Ganey,
and how getting those scores as high as possible is the ultimate goal.
This study was conducted in fulfillment of requirements of the Aramark Distance Learning
Dietetic Internship. The study was conducted with the permission from Holy Redeemer Health
System. The information provided from this study will help identify if the Patient Connect App
increases patient satisfaction and help identify department problems and how to better satisfy
their patients.
Thank you for your consideration of this manuscript.
Sincerely,
Rachel Sedgwick, BS
Dietetic Intern
Aramark Healthcare Distance Learning Dietetic Internship
Philadelphia, PA
Rsedgwick14@gmail.com
May 2015
Emerging Trends
The effect of the Patient Connect Application on the patient satisfaction scores in Press Ganey
Word Count: 2,896
Rachel Sedgwick, BS
Dietetic Intern
Aramark Healthcare Distance Learning Dietetic Internship
Philadelphia, PA
Rsedgwick14@gmail.com
Abstract
Patient satisfaction has always been one of the most important aspects for a hospital, because
without happy patients, there are no patients. Press Ganey is a large patient satisfaction survey
that provides feedback to the public and hospitals that identify which hospitals are most patient
satisfying. Holy Redeemer Hospital’s Food Service department has identified patient
satisfaction with food a main source of influence on their operation. The department identified a
need to join the movement of the Patient Connect App tablet which surveys patients during their
hospital stay that identifies their satisfaction with the food and nutrition department. The tablet
was used on Maternity and 3North floors to identify if its usage increases the patient satisfaction
scores. The study gathered data for months and the results were inconclusive, in that they were
inconsistent. 3/5 floors satisfactions scores increased while 2/5 floors satisfaction scores
decreased. Many variables were identified during this study that would need further evaluation
to determine their effects on the results. The Patient Connect App was helpful in identifying
minor patient concerns while they were happening, which overall does help make patient
satisfaction improved. With further study control and development, the evaluation of the success
of the Patient Connect App could be determined.
Introduction
Hospitals have been growing and changing to keep up with the times. They have been
adapting to the new medications, the new diseases, and the new technologies. Hospitals now are
changing to online medical records, databases, have their own hospital websites, and more. One
of the main important changes that hospitals have adapted is the importance of patient
satisfaction. Press Ganey was developed in 1985 which is a survey of a specific set of questions
for patients to fill out about their experiences while staying in the hospital.1 These scores reflect
back on the hospital, both good and bad reports. The Press Ganey survey initially was optional
to help identify the hospital’s strengths and weaknesses. Only few hospitals used the Press
Ganey program, but slowly more and more hospitals joined. In 2007 there was a huge influx of
hospitals using Press Ganey because hospital reimbursement’s became directly affected by
inpatient satisfaction ratings as a part of the Centers for Medicare and Medicaid Services. The
hospital participation rate increased 95% from before in order to get the reimbursements. 1
The Press Ganey survey is a very important part of the hospital’s successes and
advancements currently. Since 2008 the Press Ganey survey is available for the public to view,
which makes the hospitals a lot more competitive. Patients are more likely to go to a better rated
hospital for patient satisfaction if they have a choice in the matter and it is not a medical
emergency. No one would want to go to a hospital with low patient satisfaction scores. Dietary
is one of the areas that are scored on the Press Ganey survey. The food and nutrition department
is a big part of what makes patients happy and satisfied because they feed them during their stay.
It is important to gain good patient satisfaction scores in order to get more reimbursement. So
hospitals now need to find ways to better and improve themselves even more because they want
to be highly ranked amongst competitors in the area.
Many hospitals are finding that their Press Ganey patient satisfaction scores are not
where they would like them to be compared to other local hospitals. The only way to improve
them is to come up with interventions to try and increase their scores. A study that was
developed by the Ohio State University Medical Center used a tablet specially equipped with
reporting tools, dashboards, scoreboards, and tracking reports.2 With the use of the tablet
receiving feedback from the patients, Ohio State University Medical Center improved on its
Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) scores. In 2006
the hospital received 56% 9’s and 10’s and then in 2009 received 71% 9’s and 10’s which is a
significant increase.2 The use of the tablet survey allowed for the hospital to have a better
understanding of the patients concerns. The increased HCAHPS scores indicates that the
hospital made the necessary changes to make their patients happier with their services they are
provided. A second study in Buffalo Hospital developed a randomized control trial because they
were receiving low Allina Survey scores for the patient satisfaction in the Emergency Room
department. The Allina Survey scores are similar to the Press Ganey scores. The ER department
reported receiving great marks while treating and caring for the patients, but their survey scores
would reflect as performing poorly. They tried using suggestion box, mail in survey, and other
means of communication between patient and hospital and nothing would increase their scores.
The hospital ER department developed the use of a tablet survey. They used the program Point
of Care by TruthPoint that is an in room survey given to the patient that gathers confidential
feedback about their care and service.3 The surveys generated reports to interpret what needed to
be changed. The results of the study showed that with the use of the tablet, the Allina survey
participation increased from 150 survey participants for 3 months to 2,400 participants for 3
months for the ER department. And their patient satisfaction with the ER department increased
from 38% to 74% on Allina surveys.3 The increase is a huge positive and success for this
hospital because the hospital took their patients comments and suggestions and made
improvements.
Communication is key in society. A patient constantly evaluates their interactions with
the health care staff as how they interpret their entire hospital stay.1 If a person has a missing
item from their tray they could be upset, but as soon as someone from the department apologizes
and tries to correct the situation, the patient will feel much better about the situation. On the
other hand if a patient has a missing item on their tray and had a bad interaction or no interaction
with the department, that patient will score their whole dietary experience based on that one bad
experience. A patient cares more about how workers treat them and show concern for their
needs, rather than something materialistic. An in-person interaction showing that the dietary
department wants to help and fix the problem is more what the patient will remember and use
when they rate the patient satisfaction of the nutrition department. A study found that when
doctors communicate their plan of action during initial consultations with patients, allowing
them to ask questions and concerns, actually increased the patient satisfaction score for
information provided and explained, feeling of trust and confidence in their surgeon, and
reduction in post-surgery decision regret.4 Many patients just want to feel that they are a person
being cared for and not just a patient, and so increased communication amongst hospital
employees and the patient will help them feel more satisfied. Cleveland Clinic wanted to
improve their HCAHPS communication scores and so initiated the usage of a tablet survey to the
patients before discharge about their stay and communication. With the immediate feedback
from the patients to the physicians through the tablet survey, the physicians could make minor
adjustments in their day to day work to try and improve their scores. Six months post
intervention the physician communication increased from 72.8% to 81.4% on HCAHPS.5 This
is a great improvement and accomplishment for those physicians because they found out what
was making their scores low and adjusted them to make their patients happier. Another study
developed in an emergency room department of a hospital wanted to initiate the usage of a tablet
survey for their patients about the satisfaction of their care they were provided. The tablet would
be handed to each patient to fill out the survey individually. The results of the study showed that
before the tablet survey patient satisfaction was 76.4% and after the tablet survey was 76.9%, so
it did not improve the scores for the department.6 Reasons why this study did not show
improvement could be due to barriers to the use of technology for some patients, and there was
no person to person interaction. Interactions amongst one another are key for hospital success.
Patient Connect is a developing application that hospitals are using to evaluate patient
satisfaction for environmental services and nutritional services. The use of this app for patient
rounding can increase patient satisfaction scores on Press Ganey as much as 22%.7 With the use
of the app, the department is able to determine the problems and concerns the patients have and
address them within a timely manner. The app is similar to the studies above because it provides
reports and scores, and concerns and suggestions by patients to the supervisor which allows the
department to better themselves. This App allows hospitals to do patient rounding 5-10 times
faster than on paper, which allows for more feedback and ability to improve.7 This tablet allows
for the hospital to go around to patients and receive feedback on quality, staff, temperatures, and
ordering for the nutrition department. The supervisor goes into patients’ rooms and delivers the
survey. The supervisor can fix an immediate problem directly, or if it is a past concern can
document it and address it with the department. There are 6 questions asked to the patient, 3
standard that correlate with the Press Ganey questions, and 3 that can be changed with the needs
of the hospital. The use of the Patient Connect app provides feedback for the department to help
improve the Press Ganey scores for the nutrition department. With the use of the tablet, the
department can better identify areas for needed improvement and can better satisfy their patients.
Methodology
The study used a cross sectional design which identified if the use of the tablet is actually
successful. The study examined the Press Ganey scores for all of the floors before the use of the
tablet, and then examined the scores after the use of the tablet is implemented. For the study, the
tablet was only to be used on Maternity and 3North to determine the success of the tablet.
Maternity patients are young females who are typically healthy and able to give sound feedback,
and 3 North is a male and female post-operative patients. With having some floors as the
control, it was easier to determine if the tablet was the cause of the increased scores rather than
the food/service being the improvement. It was projected that 3 North and Maternity scores
should improve compared to their scores before the tablet survey, and compared to the other
floors scores without the tablet survey. If 3 North and Maternity’s scores did show
improvements in both of these areas then this proves that the use of the tablet survey actually
does have an impact on the Press Ganey scores and is a useful tool for the hospital.
The subject recruitment of 3 North and Maternity were convenience samples because
those floors are always filled with patients due to the unit’s popularity. Holy Redeemer has a
very large maternity unit and so the maternity floor is always full of patients who were willing to
provide feedback to the department. 3 North is a wing for GI related issues, these patients are of
all ages and both genders which also gives a wide variety of responses and point of views for the
department. The bulk of the patients used in the study are young women who will
deliver/delivered and so will typically have a short stay in the hospital which allows for high
turnover rates and more rounds to be done. The Maternity and 3 North patients were
Philadelphia/Abington locals. Maternity patients were females with families, and were around
the ages of 16- 45, while 3 North patients were a mix of males and females ages 20- 100+. The
exclusions of patients for this study were patients on other floors of the hospital such as ICU, or
they were floors that most patients are in/out of surgery and unable to eat so they were not fit to
provide feedback to the department.
The equipment used was a pre-developed tool called the Patient Connect App which
provided 6 questions to ask the patient, three of which are set questions that directly correlate
with the nutrition questions on Press Ganey, and three which are able to be altered for the needs
of the hospital. The three changeable questions were tailored to Holy Redeemers nutrition
department needs. The tablet cost the department $189.00 one-time purchase, and the
department pays a monthly due to Aramark of $180.00 to be a part of the program. The
computer program with the data analysis and charting is a part of the monthly dues. The time
and labor is already accounted for due to not hiring a new employee but using a supervisor to do
the rounding.
This study gathered information through the Patient Connect tablet which provided
patient with an in-person survey/questionnaire. It provided qualitative and quantitative
information but the data that was examined to see if the study is successful was exclusively
quantitative data with averages, means, and medians. With the data collected, an excel
spreadsheet was developed to analyze the data and the study’s success. The data provided to the
department by the use of this tablet and study will help the department to determine if they
should continue the usage of the tablet and expand it to all floors of the hospital, and what areas
of the department need to be improved upon for better patient satisfaction.
Results
The Patient Connect App was useful for the nutrition department in helping understand
where the problem areas were before the Press Ganey surveys. However, the use of the Patient
Connect App did not provide consistent increased Press Ganey scores. The scores provided by
each floor through the App showed that most of the floors were fairly pleased with the nutrition
department, but when the Press Ganey scores were received the scores are significantly lower as
shown in graph 1. Table 1 displayed that the Maternity Patient Connect mean was 94.31 while
the Press Ganey mean was 84.38. The 3North Patient Connect mean was 92.72 while the Press
Ganey mean was 83.26. The tablet was to be used on maternity and 3 north floors only in order
to compare to the other “control” floors, but rounds were provided on all floors which makes the
identification of the App influence on scores more difficult. The Patient Connect App was not
fully initiated at Holy Redeemer until the month of September 2014. Graph 2 provides a
comparison of the average Press Ganey scores from before the Patient Connect initiation,
compared to the average Press Ganey scores from after the initiation. This graph shows that the
scores are not consistently increased on all of the floors after the App usage was launched; 3 of
the 5 floors increased scores while 2 of the 5 floors decreased scores. The main floors of the
study, Maternity and 3 North, had mixed results. Maternity did have an increase in Press Ganey
scores of 1.70%, and 3North floor had a decrease in Press Ganey scores of 1.60%. Table 1
provides full details of all of the data collected for the study.
Discussion
The Patient Connect App being used at Holy Redeemer Hospital has greatly helped to identify
problems and concerns of patients quicker than before the App usage. It was also very helpful
for when a patient would provide specific details to the rounder, which was then entered into the
tablet to be reviewed at a later time with management. This direct feedback has been very useful
in itself for the department. On the other hand, the usage of the Patient Connect App results was
not as clear. The results were very unpredictable and need further investigation in order to
determine if the Patient Connect App actually influences the scores of Press Ganey. The App
usage helps with the small detailed needs/fixes of the nutrition department, but does not seem to
have quality effects on the Press Ganey scores of the nutrition department for Holy Redeemer
Hospital. The variability of the tablet and Press Ganey results shows that the tablet may not
provide as much secure benefits as other studies have shown. There are many variables in this
study that could affect the results of the study. For instance, the rounder did not do rounding
regularly; they were very sparse and inconsistent. Also the rounds were given on all floors not
just maternity and 3North which eliminated the “control” floors to help determine the effect of
the App. Another variable was that the tablet survey was given in person and not anonymously
so a lot of people may have felt apprehensive to give their true opinions. And lastly, a lot of
surveys that were completed got deleted multiple times without transmitting over to the database
due to technical errors which caused a missing amount of surveys and data that could have
altered the average scores. The other studies above did find success with the usage of the tablet
survey while one did not have success but did identify department difficulties, this study seems
to be similar to that. While not completely successful in increasing Press Ganey patient
satisfaction scores the study did show underlying benefits for the department.
Conclusion
The Patient Connect App usage helped the nutrition department in many ways. It showed the
strengths and weaknesses of the department in a timely manner compared to before. The
nutrition department was able to identify which foods were least liked by the patients and why,
which servers were most friendly, etc. Although not fully successful during the study, the App
should continue to be used to further identify its capabilities. Due to the weaknesses of this
study it is important to test the Patient Connect App further with more restrictions. When the
App is to be studied further, there should only be one floor being tested compared the other
“control” floors, there should be no lost surveys, surveys completed daily and a specific amount,
etc. This amount of control should help next time to further identify how the App can help the
nutrition department and the dietitians in what the hospital patients need/want to improve their
satisfaction. Once this Patient Connect App is identified as truly increasing patient satisfaction
at Holy Redeemer Hospital like it has at other places, it would be the next big step for the
department to be able to provide the proper nutrition therapy and healthy food to patients and
have it be valued and appreciated.
Results:
Graph 1: Average Patient Satisfaction scores for Press Ganey and Patient Connect App
Average Patient Score (Sept-Feb)
100
95
90
85
Press Ganey
Patient Connect
80
75
Graph 2: Press Ganey Averages from before and after the usage of the Patient Connect App
Press Ganey Averages
86
84
84.8
83.1
84.8
84.3
83.2
82.83
82.92
83.72
82.55
82
Press Ganey before App
80
78.45
Press Ganey after App
78
76
74
Maternity
Telemetry
2South
3North
3South
Table 1: Press Ganey and Patient Connect Scores for all floors
Maternity
Column1
Press Ganey
Patient Connect
July
84.8(35)
0(0)
August
81.4(38)
91.7(1)
September 87.5(16)
89.79(48)
October
90.3(25)
0(0)
November 81.1(19)
95.34(47)
December 77.0(21)
95.83(16)
January
86.1(6)
96(76)
February
86.9(7)
97.22(64)
**(-) means amount of rounds/surveys
Telemetry(2North)
Press Ganey2 Patient Connect2
79.9(24)
0(0)
89.7(30)
0(0)
85.6(30)
91.37(11)
86.8(17)
87.96(10)
77.4(30)
0(0)
82.2(34)
0(0)
83.3(11)
0(0)
83.9(14)
97.78(17)
2South
Press Ganey3 Patient Connect3
75.2(23)
0(0)
81.7(23)
0(0)
87.4(27)
85.65(28)
81.1(19)
92.71(8)
83.3(18)
96.25(21)
81.6(24)
0(0)
81.8(8)
95.63(22)
81.3(8)
0(0)
Press Ganey4
80.2(8)
88.4(18)
80.0(20)
82.1(13)
83.3(15)
81.7(10)
77.1(10)
93.3(5)
3North
Patient Connect4
0(0)
83.33(1)
84.72(8)
96.67(5)
95.51(14)
98.08(14)
95.83(24)
94.91(19)
Press Ganey5
82.1(46)
83.0(27)
87.8(45)
84.9(37)
86.0(37)
81.9(34)
81.8(27)
79.9(23)
3South
Patient Connect5
0(0)
100(1)
94.38(38)
96.88(8)
96.57(17)
0(0)
95.14(20)
98.61(36)
Work Cited
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https://legacy.aramark.com/owa/WebReadyView.aspx?t=att&id=RgAAAABMIxNgNbq
0T6q3FyCRlijgBwBF4XZU1jLIRIBTT6aAehglAAIf3TXCAABF4XZU1jLIRIBTT6aA
ehglAAQTO0ueAAAJ&attid0=EACK%2bZDIVVDDRqsBnxW6AATD&attcnt=1
Appendix: